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Akman: CHARGE AND HIPPOCRATIC OATH

(MD DIPLOMA CEREMONY, 5/20/18)

As we move to the conclusion of our ceremony, it is a GW tradition for the dean to make brief remarks to the graduates prior to the recitation of the Hippocratic Oath. As we frequently hear it called in politics, I am here to speak to my base.

Graduates, as you know, there are two stone benches with iron railings that frame the I Street corridor in front of Ross Hall. You have walked past them countless times.

On the gate above the west bench closer to 24th street are the words "seek truth and pursue it steadily."

At last year's Commencement I reflected on those words and their meaning in medicine and science in a post-truth world. I spoke about truth, integrity and honor, fundamental core values for a physician.

I can't think of a more important time to speak about truth and honesty, however, today I want to speak about the words on the other bench closer to 23rd Street: “joy of healing those who seek my care”. The joy of healing those who seek my care; words or sentiment that hopefully speak to you and to all of the physicians in this room.

As Dean Haywood reminded you, the signing of our Honor Code at the White Coat Ceremony was for each one of you, the last official act that you performed before beginning medical school.

These words (and similar words in the Hippocratic Oath) speak to our calling as physicians. In our version of the Oath we actually use the word "sacred" in the opening. This word reminds us that this historic oath was originally a religious vow made to the gods in ancient Greece, but now speaks to the inviolable nature of the commitment that we are making.

We pursue a career in medicine for many reasons—but what is it about turning a career into a calling or vocation? That is “a commitment to work that is personally meaningful, purposeful and has consequence to the world beyond one's self."

So let's highlight three words on the bench—joy, healing and care.

"Joy"—from the Latin word for rejoice. Some have said that joy is a feeling in our soul. One theologian wrote that "the root of joy is gratefulness...it is not joy that makes us grateful; it is gratitude that makes us joyful." When viewed this way, it reflects that the physician (and not the patient) is grateful for the healing experience.

"Healing"—from the Old English word for whole. The physician and author Abraham Varghese directly links healing and calling. "My desire to be a physician had a lot to do with that sense of medicine as a ministry of healing, not just a science. And not even just a science and an art, but also a calling, also a ministry."

And "care". It is also a word with multiple meanings. On the bench, one probably reads care as implying medical care or health care. However, as author and Rabbi Harold Kushner wrote, “caring about others, running the risk of feeling, and leaving an impact on people, brings happiness.” It speaks to the potential reward, happiness, which can be achieved through intimacy and psychological vulnerability. As you know, this is central to the calling to medicine.

However, your calling transcends the doctor-patient relationship. There is also the prosocial aspect of your calling—behaviors benefiting other people or society as a whole—and what motivates you to engage in those behaviors. This part of what defines a calling moves us further into your character and your values as professionals and humanists.

The societal aspect of one's calling to medicine leads me to the other words on that bench. Words inscribed on a plaque on the right side of the iron railings. The plaque honors the memory of a former GW medical student, resident and clinical faculty member named Steven Dixon who died in 2002 at the age of 43 in an accident.

How did that plaque get mounted on that gate? And who was Dr. Steven Dixon? In full disclosure, Steve Dixon was my partner of close to 20 years when he passed away. The leadership of the university at that time dedicated the plaque in his memory. I was the chair of the GW psychiatry department at that time and I made a personal request that the plaque be attached to the bench directly in front of Ross Hall that reads the “joy of healing those who seek my care".

For much of Steve Dixon's career as an obstetrician/gynecologist, joy was at the center of his calling. He was a gifted clinician and, in his brief career, delivered over 2,000 babies. He loved providing care to women. He was also an outstanding teacher and mentor. In fact, he loved teaching medical students, residents and midwives. These things truly brought him joy.

Yet, growing up gay in the south in the 1960s and 70s was no easy task for Steve with obstacles that made his calling to medicine far from a sure thing. But he excelled academically and graduated as valedictorian of his high school class before attending a small, highly regarded Southern Baptist college. Despite his excellent grades in college, when he was outed as gay the administration moved to expel him. But, with the support of a courageous student affairs dean he was able to complete his degree in 3 years and avoid expulsion. It was his admission to medical school that broke the estrangement with his father who had stopped talking to him when he learned he was gay.

Steve and I met as GW med students and became a couple in 1983 when I was a resident. It was soon evident that we would face the terror of the early years of the HIV/AIDS epidemic together. We learned a great deal about ourselves as we gave our time and energy to tend to our dying friends, help build a community response to HIV/AIDS and fight the stigma and bigotry that was fueling the epidemic. We did not use the term “social justice” in those days, but that was a central part of what we were fighting for.

Steve led many of the early AIDSWalks in DC and helped raise millions of dollars to support local HIV/AIDS services. He served as the National Coordinator for the 1996 National Candlelight March Against AIDS. In his private practice, if a woman came out to him as a lesbian, he gave her free care for the remainder of her time in his practice.

In addition to being a physician, the plaque says that Dr. Steven Dixon was a “humanitarian”. But it’s only when you include the words above the plaque, the “joy of healing those who seek my care”, that you get the full understanding of his calling to medicine. His calling included the patient, the learner and something greater than himself. In many ways, he was the epitome of the GW medical student and physician.

Graduates, you are truly a remarkable group. I am have been inspired by your commitment and dedication to learning and to your patients and their families; your civility and professionalism; your collegiality, flexibility and thoughtfulness as we rolled out a revised curriculum; your embrace of the diversity of your classmates and your patients; and your deep sense of service and altruism.

As you know, we are in the midst of a very challenging time in the history of our country. During your years in medical school our country seems to have become less civil and more divided. This dissonance is amplified in Washington, DC, however, our location also provided you many public opportunities to resist by engaging in advocacy through protests and demonstrations such as WhiteCoats4BlackLives, the Women’s March, #MarchforOurLives and the March for Science.

Graduates, having gotten to know many of you, I know that you experience the discordance between what is happening in our country and what is happening inside of you. Yet in many ways, your professional calling is a powerful response to those same challenges facing this country. In your daily efforts with patients and their families, you manifest the quiet, personal resistance to division, racism, sexism, gun violence and dishonesty through your compassion, empathy and integrity. It is what your call to healing is about.

This year I found myself attracted to a series of books about character, behavior, morality and hope. Dov Seidman in How: Why How We Do Anything Means Everything, talks about sustainable values, those that connect us deeply as humans, including integrity, honesty, truth, humility and hope. Values that are all about how, not how much. These are the same values that just happen to form the basis of your new profession.

New York Times columnist and author David Brooks wrote in The Road to Character that among the characteristics of what we call character is the ability to “stay attached to people and causes and callings consistently through thick and thin.” And, ultimately, Brooks rejects the traditional commencement charge of “be true to yourself,” which he views as inherently narcissistic. Instead he says that “those with a calling do not ask what do I want from life? They ask, what is life asking of me?”

And so doctors, today I charge you to reflect on your calling to medicine and ask yourself, what is life asking of me? Altruism and a deep sense of our shared humanity forms the basis for your calling. Stay in touch with the joy and gratitude inherent in healing and don’t let the electronic medical records get you down! Ultimately, our place among the healing professions is about our love for our fellow man and our capacity to care for each other.

I charge you to sustain your call to service and advocacy that brought you to GW for medical school. There is so much that needs to be done in our communities, in our country, and around the world. Strive to be the physician-citizen, the physician-officer or the physician-activist that will make an impact beyond the exam room.

And, yes, I charge you to seek truth and pursue it steadily. Conduct your lives with integrity. When you signed your medical school’s honor code it did not have an expiration date. To quote Dov Seidman, “principled behavior is the surest path to success and significance…in life.”

And to our newest GW medical alumni, I charge you to stay engaged with your alma mater. We want to know how you are doing and we want to take pride in your achievements. We want to stay involved with you.

And so the tradition continues; the inspiring tradition that new physicians recite the Oath of Hippocrates and publicly acclaim those values that remain as the foundation of our calling.

The GW tradition is that, in addition to our graduates, we invite all physicians in the audience to reaffirm their vows.  

I will ask several groups of physicians to please rise to say the Oath of Hippocrates. Please stay standing until after the oath is completed.

  • I invite all physicians who are parents, grandparents, spouses and significant others of our graduates to please stand.
  • Next, I invite (other than today’s graduates) any and all GW medical school alumni please rise.
  • Again, except for the graduates, would all other physicians present stand?
  • And finally, will the class of 2018 join your physician colleagues, and rise?

Will all who are standing, join me in affirming or reaffirming our commitment to the best in the practice of medicine. The Oath can be found on page 2 of your program.

Please repeat after me.

“I DO SOLEMNLY SWEAR BY THAT WHICH I HOLD MOST SACRED

THAT I WILL BE LOYAL TO THE PROFESSION OF MEDICINE

AND JUST AND GENEROUS TO ITS MEMBERS;

THAT I WILL LEAD MY LIFE AND PRACTICE MY ART IN UPRIGHTNESS AND HONOR.

THAT INTO WHATSOEVER HOUSE I SHALL ENTER,

IT SHALL BE FOR THE GOOD OF THE SICK TO THE UTMOST OF MY POWER,

I, HOLDING MYSELF ALOOF FROM WRONG, FROM

CORRUPTION, FROM THE TEMPTING OF OTHERS TO VICE; THAT I WILL EXERCISE MY ART SOLELY FOR THE CARE OF MY PATIENTS,

AND WILL GIVE NO DRUG, PERFORM NO OPERATION, FOR A CRIMINAL PURPOSE,

EVEN IF SOLICITED, FAR LESS SUGGEST IT;

THAT WHATSOEVER I SHALL SEE OR HEAR OF THE LIVES OF

PEOPLE WHICH IS NOT FITTING TO BE SPOKEN I WILL KEEP INVIOLABLY SECRET.

THESE THINGS I DO PROMISE AND IN PROPORTION AS I AM

FAITHFUL TO THIS MY OATH MAY HAPPINESS AND GOOD

REPUTE BE EVER MINE;

THE OPPOSITE IF I SHALL BE FORSWORN.”

Congratulations, Doctors and Colleagues!!